| NPI | 1154523363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist |
| Additional Taxonomies | 224P00000X Prosthetist |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: NC C46772) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2024-02-20 |